By Karen Blum
A program in which managed care pharmacists reached out to healthcare providers in 2023 to advise them of potential cost savings that could accrue by switching their patients with multiple sclerosis (MS) from branded to generic therapies has generated significant savings.
Pharmacists with the HighTouchRx program, operated by Prime Therapeutics/Magellan Rx Management, reviewed claims data from 807 patients taking brand-name MS drugs in 2023. Their outreach to providers resulted in 141 instances (18%) in which the provider switched the patient to a generic equivalent, at an estimated total savings of just over $10.3 million.
An additional 37 cases are still in the review process and, if switches occur, could result in nearly $2.9 million in further savings, the investigators reported in a gold award–winning poster (G17) at AMCP 2024, in New Orleans.
“With branded generic therapies, we recognize that there’s essentially an equivalence rubber stamp that’s been provided by the FDA to say this is a clinically appropriate recommendation that’s been issued, and we need to layer on additional clinical insights to drive that [switch],” said lead study author Nicholas Friedlander, PharmD, a clinical programs pharmacist with Prime Therapeutics/Magellan Rx Management, a pharmacy benefit manager that works largely with Blue Cross Blue Shield health plans. “Soft steering, this type of intervention, is what we think is an ideal pull-through strategy for that as an adjunct to some of the more upstream interventions.”
The pharmacists’ brand-to-generic case review processes typically involved a review of member and claims history based on ongoing brand MS therapy, determination of final member cost share for the therapy after any applicable manufacturer coupons, and anticipated generic drug member cost share. The analysis was facilitated by a web tool for the HighTouchRx program, Dr. Friedlander noted.
Pharmacists reviewed data for 375 patients taking fingolimod (Gilenya, Novartis), 336 taking teriflunomide (Aubagio, Sanofi Genzyme), 42 taking dalfampridine (Ampyra, Acorda), 35 taking glatiramer acetate (Copaxone, Teva) and 19 taking dimethyl fumarate (Tecfidera, Biogen). Their outreach led to changes to generic medications for 84 patients (22%) on fingolimod, resulting in an estimated $6.7 million in savings; 55 patients (16%) on teriflunomide, with an estimated $3.5 million savings; and one patient each taking dalfampridine and dimethyl fumarate. The dimethyl fumarate switch resulted in an estimated $100,000 savings.
These changes led to a 68.4% decrease in total monthly per-member per-month cost, from $0.98 in January 2023 to $0.31 in December 2023. Monthly expenditures decreased most substantially for teriflunomide (82%) and fingolimod (72%). The largest month-to-month change in total per-member per-month cost occurred between March and April 2023, decreasing from $1.08 to $0.50. This coincided with the release of the first generic teriflunomide products.
In 423 cases (52% of the total outreach), managed care pharmacists found no opportunity to switch to a generic. This resulted from a variety of reasons, including previous brand utilization management authorizations; a switch potentially resulting in increased cost share for patients; or a member already switching to a generic or alternative MS therapy prior to the pharmacists’ outreach.
Health insurers do “everything they can to try to ensure that safe and effective generics medications are used, and that generics are used when they are available," said study co-author Patrick Gleason, PharmD, BCPS, FCCP, FAMCP, the assistant vice president of Health Outcomes at Prime Therapeutics. This can be done, he noted, via strategies such as establishing formulary benefit designs and encouraging utilization management and step therapy. “Yet you still have patients that end up, for whatever reason, continuing on the brand product.”
HighTouchRx can provide “an extra step,” Mr. Gleason said. The program targets all drug therapies costing $1,000 or more that have available generic equivalents.
The study was sponsored by Prime Therapeutics LLC. Drs. Friedlander and Gleason reported no relevant financial disclosures beyond their stated employment.